CLINICAL SPECIALITY – II

OBSTETRIC AND GYNAECOLOGICAL NURSING

Placement – II year Hours of instruction Theory: 150Practical: 950Total: 1100

Course description

This course is designed to assist the student in developing expertise and in-depth

understanding in the field of obstetric and gynecological Nursing. It will help the student to develop

advance-nursing skill for nursing interventions in various obstetrical and gynecological conditions. It

will further enable the students to functions as midwifery nurse practitioner / specialist, educator,

manager and researcher in the field of obstetric and gynecological nursing.

Objectives

At the end of the course, the student will be able to:

1. Describe the epidemiology, etiology, pathophysiology and diagnostic assessment of women

with obstetric and gynecological conditions

2. Perform physical, psychological, cultural and spiritual assessment

3. Demonstrate competence in caring for women with obstetrical and gynecological conditions

4. Demonstrate competence in caring for high risk newborn

5. Identify and manage obstetrical and neonatal emergencies as per protocol

6. Practice infection control measures

7. Utilize recent technology and various diagnostic, therapeutic modalities in the management

of obstetrical, gynecological and neonatal care

8. Demonstrate skill in handling various equipments / gadgets used for obstetrical,

gynecological and neonatal care

9. Teach and supervise nurses and allied health workers

10. Design a layout of specialty units of obstetrics and gynecology

11. Develop standards for obstetrical and gynecological nursing practice

12. Counsel women and families

13. Incorporate evidence based nursing practice and identity the areas of research in the field of

obstetrical and gynecological nursing

14. Function as independent midwifery nurse practitioner

SN UNIT TOPIC THEORY PRACTICALSI Management of problems of women during pregnancy

Risk approach of obstetrical nursing care, concept & goals Screening of high –risk pregnancy, newer modalities of

diagnosis Nursing management of pregnancies at risk-due to

obstetrical complication Pernicious vomiting Bleeding in early pregnancy, abortion, ectopic pregnancy,

and gestational trophoblostic diseases Hemorrhage during late pregnancy, ante partum,

hemorrhage, placenta praevia, abruptio placenta Hypertensive disorders in pregnancy, pre –eclampsia,

eclampsia, heomolysis elevated liver enzyme, Low platelet count (HELLP)

I so –immune diseases. Rh and abo incompatibility Hematological problems in pregnancy Hydramnios –oligoydramnios Prolonged pregnancy post term, post maturity Multiple pregnancies Intra uterine infection & pains during pregnancy.

Intra uterine Growth Retardation (IUGR), premature rupture of Membrane (PROM), intra uterine death

25

II Pregnancies at risk-due to pre existing health problems Metabolic conditions Anemia and nutritional deficiencies Hepatitis Cardio-vascular disease Thyroid disease Epilepsy Essentials hypertensions Chronic renal failure Tropical diseases Psychiatric disorders Infections Toxoplasmosis rubella cytomegalo virus

Herpes (TORCH): Reproductive Tract infections (RTI): STD: HIV/AIDS, vaginal infections; Leprosy, Tuberculosis

Other risk factors: Age-Adolescents, elderly; unwed mothers, sexual abuse, substance use

Pregnancies complicating with tumors, uterine anomalies, prolapse, ovarian cyst

15

SN UNIT TOPIC THEORY PRACTICALSIII Abnormal labour, pre-term labour & obstetrical emergencies

Etiology, pathopyhsiology and nursing management of o Uncoordinated uterine actions, Antony of uterus,

precipitate labour, prolonged labouro Abnormal lie, presentation, position compound

presentation o Contracted pelvis –CPD; dystociao Obstetrical emergencies Obstetrical shock, vasa praevia,

inversion of uterus, amniotic fluid embolism, rupture uterus, presentations and prolapse cord

o Augmentation of labour Medical and surgical induction o Version o Manual removal of placentao Obstetrical operation: Forceps delivery, Ventouse,

Caesarian section, Destructive operations o Genital tract injuries –Third degree perinea tear

,VVF,RVF Complications of third stage of labour:o Post partum Hemorrhageo Retained Placenta

15 + 2

IV Post partum complications Nursing management of oPuerperal infections, puerperal sepsis, urinary complications, puerperal venous thrombosis and pulmonary embolismoSub involution of uterus, breast conditions, Thrombophlebitis Psychological complications, post partum blues, depression, psychosis

10

V High Risk Newborn Concept, goals, assessment, principles. Nursing management of • Pre-term, small for gestational age, post –mature infant, and

baby of diabetic and substance use mothers• Respiratory conditions, asphyxia neonatorum, neonatal

apnea meconium aspiration syndrome, pneumo thorax, pneumomediastnum

• Icterus neonatorum • Birth injuries • Hypoxic alchemic encephelopathy• Congenital anomalies• Neonatal hypocalcaemia, hypoglycemia, Hypomagnesaemia• Neonatal heart diseases• Neonatal hemolytic disease • Neonatal infections, neonatal sepsis, opthalmia neonatorum,

congenital syphilis, HIV/AIDS• Advanced neonatal procedures • Calculation of fluid requirements• Hematological conditions - erythblastosis fetalis,

hemorrhagic disorder in the newborn• Organization of neonatal care, services (Levels), transport,

neonatal intensive care unit, organization and management of nursing services in NICU

25

SN UNIT TOPIC THEORY PRACTICALSVI HIV / AIDS

HIV positive mother and her baby Epidemiology Screening Parent to child transmission (PTCT) Prophylaxis for mother and baby Slandered safety measures Counseling Breast feeding issues National policies and guidelines

Issues: Legal, ethical, Psychosocial and rehabilitation role of nurse

15

VII Gynecological problems and nursing management Gynecological assessment Gynecological procedures Etiology, pathophysiology, diagnosis and nursing

o Menstrual irregularitieso Disease of genital tract o Genital tract infectiono Uterine displacement o Genital prolepseso Genital injuries o Uterine malformation

Uterine fibroid, ovarian tumors, Breast carcinoma, pelvic inflammatory diseases, reproductive tract malignancies, hysterectomy-vaginal and abdominal

25

VIII Infertility • Primary and secondary causes• Diagnostic procedures• Counseling : ethical and legal aspects of assisted

reproductive technology (ART)• Recent advancement in infertility management• Adoption procedures

Role of nurses in infertility management

5

IX Menopause• Physiological , Psychological and social aspects• Hormone Replacement Therapy• Surgical Menopause• Counseling and guidance

Role of midwifery nurse practitioner

5

X Administration and management of obstetrical and gynecological unit

Design &layout Staffing Equipment, supplies Infection control: Slandered safety measures Quality Assurance :obstetric auditing –records /reports

.Norms ,policies and protocolsPractice standards for obstetrical and gynecological unit

5

SNO UNIT TOPIC THEORY PRACTICALSXI Education and training in obstetrical and

gynecological care Staff orientation, Training and development In-services education programs

Clinical teaching programs Planning Midwifery programme – GNM, B Sc, ANM,Dai /TBA

2 3

XII International & National agencies –ICM ,SOMI 1

Practicals

Total = 960 Hours1 Week = 30 Hours

Clinical practice in Obstetrical and Gynecological setting i.e., Antenatal Out Patient Department, Labor room, Pot natal / MCH clinic, NICU, Obstetrical and gynecological Operation Theatres, Gynecological ward, Post partum . MTP clinic, Infertility centers Community Health center / Primary health center.

SN Deptt. / Unit No. of Week Total Hours1 Antenatal OPD including Infertility clinics/ Reproductive

medicine, Family welfare and post partum clinic / PTCT6 180 Hours

2 Antenatal and postnatal ward 6 180 Hours3 Labor room 4 120 Hours4 Neonatal Intensive Care Unit 3 90 Hours5 Obstetric / Gynae Operation Theatre 3 90 Hours6 Gynae Ward 4 120 Hours7 CHC, PHC, SC 6 180 Hours

Total 32 Weeks 960 Hours

Essential Obstetrical and gynecological Skill

Procedure observed o ART procedureso Infertility management : artificial reproduction : artificial insemination, invirto fertilization,

and related procedureso Ultra sonographyo Specific laboratory tests o Amniocentesiso Cervical & vaginal cytologyo Fetoscopyo Hysteroscopyo MRIo Surgical diathermyo Cryosurgery

Procedure Assisted o Operative deliveryo Abnormal deliveries –Forceps application, Ventouse,Breecho Exchange blood transfusiono Culdoscopyo Cystoscopy

o Tuboscopyo Laparoscopyo Endometrical Biopsyo Tubal Patency testo Chemotherapyo Radiation therapyo Medical termination of Pregnancyo Dilation and Curettage

Procedures performedo Relevant history taking obstetric/Gyno Complete General physical Examinationo Antenatal assessment - 20o Assessment of risk statuso Health education, counseling and mother craft classeso Antenatal immunizationo Assessment of intra uterine fetal well-beingo Universal precautions –effective infection control methods o Assessment of women in abnormal pregnancyo Vaginal examination and interpretation (early pregnancy, labour, post partum)o Utilization of partograph, Cervicographo Medical & surgical inductiono Conduction of safe delivery o Application of outlet forceps, delivery of breach –Burns Marshall, Loveset maneuverso Episiotomies suturingo Manual removal of placenta, placental examinationo Postnatal assessment – 20o Management of breast engorgement, while lego Postnatal counseling o Reposition of inversion of uteruso Breast care, breast exam, and drainage breast abcesso Postnatal exerciseo Newborn assessment –Ruling out congenital anomalieso Assessment of high risk newborn o Neonatal resuscitationo Apgar scoreo Monitoring neonates

ClinicallyWith monitorCapillary refill timeAssessment of jaundice

o Gastric lavageo Gastric gavageso Care of child in multi channel monitor and ventilatoro Care of child in radiant, warmer and incubutatoro Kangaroo careo Anthropometrics measuremento Neonatal reflexeso Breast feeding o Parental nutrition & fluid balance /infusion pumpo Feeding techniqueo Medication

Oral I.D

I.MI.V

o Capillary blood sample collectiono Oxygen therapyo Phototherpyo Chest physiotherapyo Parental counseling –bereaved parentso Setting of operation theatreo Trolley and table set up for Obstetrical & gynecological operations o Pap smear preparation o Taking vaginal test for ovulationo Vaginal pessarieso Gynecological therapyo Insertion of IUD and removalo Counseling infertile couple

MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES

M Sc NURSING : CLINICAL SPECIALITY I - OBSTETRIC & GYNAECOLOGIC NURSING

SECOND YEAR

SCHEME OF INTERNAL ASSESSMENT

Internal Assessment TheorySN. Techniques Number Weightage

1 Tests 2 Midterm (50 marks) 50 Prefinal (75 marks) 75

2 Other Assignment Seminar (100 marks) 100

Journal Presentation (50 marks) 50 275

Total Internal Assessment 25 Total External Assessment 75

Practical Experience Evaluation

1.Care Plan - ANTENATAL

1 50

2. INTRANATAL 1 503. POSTNATAL 1 504. Care Plan NEWBORN 1 505. CLINICAL PRESENTATION Antenatal

Postnatal1 501 50

6. CASE BOOK /JOURNAL 1 307. CLINICAL EVALUATION Antnatal, Postnatal 2 200 (100x2)8. PRACTICE TEACHING (NG EDN) 19. PREFINAL EXAMINATION 1 10010. Mid term Practical Examination 1 5011. Prefinal Practical Examination 1 100

780

UNIVERSITY EXAMINATION

1.WRITTEN EXAMINATION 75 MARKS2. PRACTICAL EXAMINATION 100 MARKS

Maharashtra University of Health Sciences, NashikM.Sc Nursing

Clinical specialty – Obstetric and Gynaecology Nursing

Subject: ------------------------------------------------- Topic: ------------------------------------

Name of the Student: ----------------------------------

Date /Time: ----------------------------------------------

Name of the Evaluator /Guide: -----------------------

SN. CRITERIA Marks allotted

Marks obtained

1AIMS AND OBJECTIVES

5

2ORGANISATION OF CONTENT

Latest information Simple to complex Application of Nursing Theory

15

3PRESENTATION

Introduction Content, relevancy Teaching technique

50

4AUDIOVISUAL AIDS

15

5SPEAKER’S QUALITIES

Appearance Confidence Communication skill Voice modulation

5

6GROUP DISCUSSION

5

7 REFERENCES 5

TOTAL100

REMARKS

SIGNATURE OF STUDENT

SEMINAR EVALUATION PROFORMA

EVALUATION CRITERIA

CASE RESENTATION TOTAL SCORE –50I. Assessment 10 History taking & Physical assessmentII. Disease condition in detail –Aetiology, Pathophysiology 10 Clinical features, investigations, Medical managementIII. Objectives of care 4IV. Application of Nursing theories 6V. Nursing diagnosis 6VI. Nursing Management 10VII. Conclusion 4

Maharastra University of Health Sciences, NashikM.Sc Nursing

Clinical speciality – Obstetric and Gynaecology Nursing

CLINICAL EVALUATION PROFORMA

Name of the Student : ---------------------------------- DURATION:-------------------------

Clinical Area :------------------------------------------------SN. CRITERIA 4 3 2 1

1. PERSONALITY & ATTITUDEGrooming & turn out

2 Able to think logically & well informed3 Attentive listener4 Communicate effectively5 Trustworthy & reliable6 Enthusiastic, interested & takes initiatives when situation demands7 Courteous, tactful & considerate in all her dealings with patient,

significant other team members.8 Displays leadership qualities9 Follows instructions & exhibits positive behavioural changes10 Complete assignments on time with self motivation & effort

11 KNOWLEDGEPossess sound knowledge of principles of obstetric Nursing

12 Has understanding of the modern trends & current issuses in obstetric Nursing practices.

13 Has knowledge of physiological changes during pregnancy, labour & puerperium.

14 Has adequate knowledge of diet15 Demonstrate evidence of self learning by current literature & seeking

help from experts in the field.

16 APPLICATION & SKILLAble to aaurately elicit health history

17 Able to perform & assist in the examination diagnostic procedures T treatment modalities.

18 Displays skill in trolly setting & assisting in instrumental deliveries & other procedures.

19 Confident & skillful in conducting normal deliveries & rendering antenatal and postnatal care of gynae patients.

20 Make relevant observation & records & reports.21 Identifies risk factors & manages emergency situations effectively &

promptly22 Works independently & makes prompt relevant decision in all situation.23 Sibmits assignments with self-motivation & effiorts24 Demonstrates sound knowledge of drugs used in Obs. And gynae

practices25 Applies Nursing theories through Nursing process in the clinical field.REMARKS: SIGNATURE OF THE SUPERVISOR

SIGNATURE OF THE STUDENT